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0 <br />994125-16 <br />Please print or type, (Form designed for use on elite (12 -pitch) typewriter.) <br />r <br />2415373 <br />Form Approved. OMB No. 2050.0039 <br />EPA f=orm 6700-22 (Rev. M5) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS 1.GenemtarlDNumber <br />2Pagolof <br />111magencyResponse Phone 14. <br />Manifest Tracking Number <br />WASTE MANIFEST CAR013021154(3 <br />2 <br />1 (8130) 53s--sml <br />000145940 DAT <br />5. Generators Name and Maiing Address Generators Site Address (it different Nen malting address) <br />SRN 38ROUIR DELTA COLLEGE SRN 3OAQUIN BELTR COLLEGE <br />21111 SOUTH CENTRIN. PORINIKY 2971 SOBTII CENTROL PRRKORY <br />Generators Phone: 11011PTAIR HOUSE CO 95391 (2119)598-9048 NOU21119 HOUSE CR _45341 (25059$-9040 <br />6. Transporter i Company Name U.S. EPA ID Number <br />_ <br />5TERICYCLE SPECIALTY HASTE SOLUTIONS INCL-1�y �„_ : PINS00a110924 <br />7. Transporter 2 Company Name U.S. EPA II) Number <br />B. Designated Facifity Name and Site Address U.S. EPA m Number <br />21ST CENTURY ENVIRORNERTAL NORRGENENT OF NEVRDR, LLC r,na.Wb4 <br />2995 REWINDS DRIVE ERST _. `ii •" ` <br />_ <br />Factiity'sphone:FLRNLL"Y, RV 89400 (1151 M-2150 NVD980895339 <br />ea, <br />tib. U.S. DOT Description (including Proper SNpong Name, Hazard Class, ID Number, <br />10. Containers <br />it. Taal ' <br />12 Orel <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Pacldng Gmup (dany)) <br />Quantity <br />Wt.Nd. <br />1. UNIO93 WE CORROSIVE LIQUIDS, 61I1ITZI96, R.O.S. ISULFURIC RCID, <br />DORI <br />IDS02 <br />I Doli <br />0 <br />X <br />SILVER NITRATE) @ 15.11 P6TI <br />OF <br />U 5 <br />P <br />2. 11_2922 WISH CORROSIVE LIQUIDS, TOXIC, N.D.S. SULFURIC RCID, <br />8092 <br />DU95 <br />551 <br />w <br />o' <br />X <br />DRRIUR CHLORIDE) D (5.1) PGIIdD <br />1 <br />Cr <br />DO <br />? <br />3. UN2Bl4 YASTE RYDROGER Pf_RUXIVE, ROU[i?US SOLUTIONS KITH NOT LESS <br />DDOI <br />551 <br />X <br />MIN 201 PUT NOT NODE TURN 411 HYDROGEN PEROXIDE S.1 (0) PGII <br />665 , <br />CF <br />043 <br />P <br />4- UN3S98 URSTE UKIDIM16 LIQUID, CORROSIVE, R.S.S. (SILVER NITRATE-, <br />D001 <br />(BOO2 <br />i RR1I <br />NITRIC RCID) 5.1 ID) Poll DQ(DU01/DO02=11101-151 <br />061,1 <br />DF <br />04id <br />P <br />191 <br />14. Special Handling lnstmctiamandAdditiond information - <br />(11 115042 -OU - MIMI LP 1 1 (2) 775443-111 - FRG1154) LP 12 (3) 775044-00 - BMW LP 13 (4) 514343-94 - <br />ER6(I4III 911ID1Z19G CORROSIVE 1— 4(j.11' ?--15� J 4— Jr <br />15. GENERATOWSIOFFEROR'S CERTIFICATION: [fiambydeclare that the contents of this consignment are fully and accumldy described above by the proper shipping name, and are classier, packaged, <br />marked and labeled/plararded, end are In all respects In proper condition forbansport sccordbtg to apol g intemationaland national govemmenlal reguiaeana. If export shipment and i am the Pdmary <br />Er, Icarifythatthe conleme of this conaignmentconform to the terms of the ageched EPAAcknoMed mem of Consent <br />Ithat the waste minimization statement identified In 40 CFPk26227(a)('d lam a large quantity genera )or(b) ' amasm mIquantltygenerator) Is true. <br />Genem esfors <br />Nnted/T Month Day Year <br />Tr 11 1 viol 12 <br />_.n <br />F— <br />16. Intemallon I tip ens ❑Ira orb U.. <br />p ❑Expodtove U.S. afenlry/exit: <br />'64 <br />z <br />Transpodersi nakee(fcrexpodsody): leaving U.S.: <br />w <br />17. TransparlerAtlmowledgmenl of _craft of Materials <br />OTtai <br />rter 1 Pdnled7fyped Name SlgnaWre ^r Menti Day Year <br />L�A.r�tf cam (Q r3 �( <br />N <br />arae <br />Trenaporter2 PdntedRyped Name S Month Day Year <br />4, <br />18, Discrepancy <br />182 Discrepancy IndcaOon Space El Quantity ❑Type ❑Residue ❑Portal Re)edinm ❑Full Najarian <br />Manifest ReferenceNumber. <br />18b.Altemale Facility (or Generator) U.S. EPA IO Number <br />J <br />U <br />u <br />Facll(Vs Phone: <br />I& Signature of Alternate Facility(a Generator) <br />Month Day Year <br />aw <br />z <br />19. Hazardous Wasta Report Management Method Codes (Le., codes for hazardous waste treatment, deposal, and recycing systems) <br />0 <br />1. <br />2 3. <br />4. <br />20.Designated FadlityOw orOpemtor.C&Umgenofmcelptmhazardousmalafaiscoveredbythemanifestexceptmnded In Item18a <br />1 <br />Prnted/Typed Name Signature Month Day Year <br />EPA f=orm 6700-22 (Rev. M5) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />